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Extracorporeal lung support for advanced lung failure: a new era in thoracic surgery and translational science

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Abstract

For the patients with progressively decompensating acute or acute-on-chronic respiratory failure, the first-choice treatment remains as mechanical ventilation. Despite the consistent value of mechanical ventilation, the majority of lung specialists are aware of its limitations, in particular for the patients with advanced lung failure, and inherent drawbacks that augment disease progression. More recently, the concept of allowing the lungs to ‘rest and recover’ has been supported by quite a few clinical studies. The pressure and volume of gas delivered to the lungs are reduced compared with mechanical ventilation. Based on recent remarkable evidence and experiences using extracorporeal lung support (ECLS) before, during and after lung transplant, there is growing interest in and expectations for the use of ECLS beyond lung transplant to encompass the entire field of pulmonary medicine. The purpose of this review article is to provide an update on evolving ECLS technologies and their effectiveness and discuss the future of ECLS for advanced lung failure as a new subspecialty in cardiothoracic surgery.

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References

  1. Van Raemdonck D, Neyrinck A, Cypel M, Keshavjee S. Ex-vivo lung perfusion. Transplant Int. 2015;28:643–56.

    Article  Google Scholar 

  2. Cypel M, Yeung JC, Liu M, et al. Normothermic ex vivo lung perfusion in clinical lung transplantation. N Engl J Med. 2011;364:1431–40.

    Article  CAS  PubMed  Google Scholar 

  3. Tane S, Noda K, Shigemura N. Ex vivo lung perfusion: A key tool for translational science in the lungs. Chest. 2017;151:1220–8.

    Article  PubMed  Google Scholar 

  4. Toyoda Y, Bhama JK, Shigemura N, et al. Efficacy of extracorporeal membrane oxygenation as a bridge to lung transplantation. J Thorac Cardiovasc Surg. 2013;145:1065–70.

    Article  PubMed  Google Scholar 

  5. Bermudez CA, Shiose A, Esper SA, et al. Outcomes of intraoperative venoarterial extracorporeal membrane oxygenation versus cardiopulmonary bypass during lung transplantation. Ann Thorac Surg. 2014;98:1936–42.

    Article  PubMed  Google Scholar 

  6. Mulvihill MS, Yerokun BA, Davis RP, et al. Extracorporeal membrane oxygenation following lung transplantation: indications and survival. J Heart Lung Transplant 2017 (Epub ahead of print).

  7. Valapour M, Skeans MA, Smith JM, et al. OPTN/SRTR 2015 Annual Data Report: Lung. Am J Transplant. 2017 (Epub ahead of print).

  8. Mason DP, Thuita L, Nowicki ER, et al. Should lung transplantation be performed for patients on mechanical respiratory support? The US experience. J Thorac Cardiovasc Surg. 2010;139:765–73.

    Article  PubMed  Google Scholar 

  9. Hayes DJ, Tobias JD, Tumin D. Center volume and extracorporeal membrane oxygenation support at lung transplantation in the lung allocation score era. Am J Respir Crit Care Med. 2016;194:317–26.

    Article  CAS  PubMed  Google Scholar 

  10. Hayanga AJ, Du AL, Joubert K, et al. Mechanical ventilation and extracorporeal membrane oxygenation as a bridging strategy to lung transplantation: Significant gains in survival. Am J Transplant 2017 [Epub ahead of print].

  11. Tong MZ. Con: extracorporeal membrane oxygenation should not routinely replace cardiopulmonary bypass as the preferred method of support during lung transplantation. J Cardiothorac Vasc Anesth. 2017;31:1509–10.

    Article  PubMed  Google Scholar 

  12. Machuca TN, Collaud S, Mercier O, et al. Outcomes of intraoperative extracorporeal membrane oxygenation versus cardiopulmonary bypass for lung transplantation. J Thorac Cardiovasc Surg. 2015;149:1152–7.

    Article  PubMed  Google Scholar 

  13. Biscottti M, Yang J, Sonett J, et al. Comparison of extracorporeal membrane oxygenation versus cardiopulmonary bypass for lung transplantation. J Thorac Cardiovasc Surg. 2014;148:2410–5.

    Article  Google Scholar 

  14. Fischer S, Bohn D, Rycus P, et al. Extracorporeal membrane oxygenation for primary graft dysfunction after lung transplantation: analysis of the Extracorporeal Life Support Organization (ELSO) registry. J Heart Lung Transplant. 2007;26:472–7.

    Article  PubMed  Google Scholar 

  15. Hartwig MG, Walczak R, Lin SS, et al. Improved survival but marginal allograft function in patients treated with extracorporeal membrane oxygenation after lung transplantation. Ann Thorac Surg. 2012;93:366–71.

    Article  PubMed  Google Scholar 

  16. Morelli A, Sorbo LD, Pesenti A, Ranieri M, Fan E. Extracorporeal carbon dioxide removal (ECCO2R) in patients with acute respiratory failure. Intensive Care Med 2017; 43: 519–30.

    Article  CAS  PubMed  Google Scholar 

  17. Kluge S, Braune SA, Engel M, Nierhaus A, Frings D, Ebelt H, Uhrig A, Metschke M, Wegscheider K, Suttorp N. Simone Rousseau. Avoiding invasive mechanical ventilation by extracorporeal carbon dioxide removal in patients failing noninvasive ventilation. Intensive Care Med 2012; 38: 1632–9.

    Article  PubMed  Google Scholar 

  18. Fischer S, Simon AR, Welte T, Hoeper MM, Meyer A, Tessmann R, Gohrbandt B, Gottlieb J, Haverich A, Strueber M. Bridge to lung transplantation with the novel pumpless interventional lung assist device NovaLung. J Thorac Cardiovasc Surg 2006; 131: 719–23.

    Article  PubMed  Google Scholar 

  19. Bartosik W, Egan JJ, Wood AE. The Novalung interventional lung assist as bridge to lung transplantation for self-ventilating patients – initial experience. Interact CardioVasc Thorac Surg. 2011;13:198–200.

    Article  PubMed  Google Scholar 

  20. Wearden PD, Federspiel WJ, Morley SW, Rosenberg M, Bieniek PD, Lund LW, Ochs BD. Respiratory dialysis with an active-mixing extracorporeal carbon dioxide removal system in a chronic sheep study. Intensive Care Med. 2012;38:1705–11.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Cove ME, MacLaren G, Federspiel WJ, Kellum JA. Bench to bedside review: Extracorporeal carbon dioxide removal, past present and future. Crit Care. 2012;16:232.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Burki NK, Mani RK, Herth FJF, Schmidt W, Teschler H, Bonin F, Becker H, Randerath WJ, Stieglitz S, Hagmeyer L, Priegnitz C, Pfeifer M, Quintel M, Moerer O. A novel extracorporeal CO2 removal system. Chest 2013; 143: 678–86.

    Article  CAS  PubMed  Google Scholar 

  23. Creech O, Krementz ET, Ryan RF, et al. Chemotherapy of cancer: regional perfusion utilizing an extracorporeal circuit. Ann Surg. 1958;148:616–32.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Jirsch DW, Fisk RL, Couves CM. Ex vivo evaluation of stored lungs. Ann Thorac Surg. 1970;10:163–8.

    Article  CAS  PubMed  Google Scholar 

  25. Steen S, Sjoberg T, Pierre L, et al. Transplantation of lungs from a non-heart-beating donor. Lancet. 2001;357:825–9.

    Article  CAS  PubMed  Google Scholar 

  26. Zych B, Popov AF, Stavri G, et al. Early outcomes of bilateral sequential single lung transplantation after ex-vivo lung evaluation and reconditioning. J Heart Lung Transplant. 2012;31:274–81.

    Article  PubMed  Google Scholar 

  27. Valenza F, Rosso L, Coppola S, et al. Ex vivo lung perfusion to improve donor lung function and increase the number of organs available for transplantation. Transplant Int. 2014;27:553–61.

    Article  Google Scholar 

  28. Stefan MS, Shieh MS, Pekow PS, et al. Epidermology and outcomes of acute respiratory failure in the United States, 2001 to 2009: A national survey. J Hosp Med. 2013;8:76–82.

    Article  PubMed  PubMed Central  Google Scholar 

  29. The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000; 342: 1301–8.

    Article  Google Scholar 

  30. Brodie D, Bacchetta M. Extracorporeal membrane oxygenation for ARDS in adults. N Engl J Med. 2011;365:1905–14.

    Article  CAS  PubMed  Google Scholar 

  31. Peek GJ, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, Hibbert CL, Truesdale A, Clemens F, Cooper N, Firmin RK, Elbourne D, CESAR trial collaboration. Efficacy and economic assess ment of conventional ventilator support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomized controlled trial. Lancet. 2009;374:1351–63.

    Article  PubMed  Google Scholar 

  32. Wong JK, Melvin AL, Joshi DJ, Lee CY, Archibald WJ, Angona RE, Tchantchaleishvili V, Massey HT, Hicks GL, Knight PA. Cannulation-related complications on veno-arterial extracorporeal membrane oxygenation: prevalence and effect on mortality. Artif Organs. 2017; (Epub ahead of print).

  33. Strueber M, Hoeper MM, Fischer S, Cypel M, Warnecke G, Gottlieb J, Pierre A, Welte T, Haverich A, Simon AR, Keshavjee S. Bridge to thoracic organ transplantation in patients with pulmonary arterial hypertension using a pumpless lung assist device. Am J Transplant. 2009;4:853–7.

    Article  Google Scholar 

  34. Schmid C, Philipp A, Hilker M, Arlt M, Trabold B, Pfeiffer M, Schmid FX. Bridge to lung transplantation through a pulmonary artery to left atrial oxygenator circuit. Ann Thorac Surg. 2008;85:1202–5.

    Article  PubMed  Google Scholar 

  35. Camboni D, Philipp A, Arlt M, Pfeiffer M, Hilker M, Schimid C. First experience with a paracorporeal artificial lung in humans. ASAIO J. 2009;55:304–6.

    Article  PubMed  Google Scholar 

  36. Muller T, Lubnow M, Philipp A, Bein T, Jeron A, Luchner A, Rupprecht L, Reng M, Langgartner J, Wrede CE, Zimmermann M, Birnbaum D, Schmid C, Riegger GA, Pfeifer M. Extracorporeal pumpless interventional lung assist in clinical practice: determinants of efficacy. Eur Respir J. 2009;33:551–8.

    Article  CAS  PubMed  Google Scholar 

  37. Sato H, Hall CM, Lafayette NG, Pohlmann JR, Padiyar N, Toomasian JM, Haft JW, Cook KE. Thirty-day in parallel artificial lung testing in sheep. Ann Thorac Surg. 2007;84:1136–43.

    Article  PubMed  Google Scholar 

  38. Skoog DJ, Pohlmann JR, Demos DS, Scipione CN, Iyengar A, Schewe RE, Suhaib AB, Koch KL, Cook KE. Fourteen day in vivo testing of a compliant thoracic artificial lung. ASAIO J. 2017;63:644–9.

    Article  PubMed  Google Scholar 

  39. Rose EA, Gelinjns AC, Moskowitz AJ, Heitjan DF, Stevenson LW, Dembitsky W, Long JW, Ascheim DD, Tierney AR, Levitan RG, Watson JT, Ronan NS, Shapiro PA, Lazar RM, Miller LW, Gupta L, Frazier H, Desvigne-Nickens P, Oz MC, Poirier VL, Meier P. Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) Study Group. Long-term use of a left ventricular assist device for end-stage heart falure. N Engl J Med. 2001;345:1435–43.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

I thank Mrs. Shannon Wyszomierski for her excellent editing the manuscript. I also thank Dr. Noritsugu Naito who is my research partner at Carnegie Mellon University for his excellent expertise in regards to the evolving technologies in artificial lungs.

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Authors and Affiliations

  1. Division of Cardiovascular Surgery, Temple University Health System and Lewis Katz School of Medicine, 3401 N. Broad Street, Suite 301, Zone C, 3rd Flr, Philadelphia, PA, 19140, USA

    Norihisa Shigemura

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  1. Norihisa Shigemura
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Correspondence to Norihisa Shigemura.

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Shigemura, N. Extracorporeal lung support for advanced lung failure: a new era in thoracic surgery and translational science. Gen Thorac Cardiovasc Surg 66, 130–136 (2018). https://doi.org/10.1007/s11748-017-0880-z

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  • DOI: https://doi.org/10.1007/s11748-017-0880-z

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